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7361 Hem/Onc Block 3 > Solid Organ Transplant > Flashcards

Solid Organ Transplant Flashcards

1
Q

Which organ has lowest risk of rejection?

a. heart
b. kidney
c. lung
d. liver

A

d. liver

lung > kidney > heart > liver

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2
Q

Recipient APCs present piece of donor to T cells which activates B cell, NK cells, etc

a. direct recognition
b. indirect recognition

A

b. indirect recognition

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3
Q

What is the primary polyclonal antibody induction Tx?

A

rabbit anti-thymocyte globulin

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4
Q

What is the primary monoclonal antibody induction Tx?

A

basiliximab (Simulect)

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5
Q

What glucocorticoid is used for induction?

A

methylprednisolone

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6
Q

T cell depletion is usually observed within a day from initiating thyroglobulin therapy

a. true
b. false

A

a. true

extremely potent T cell depletion

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7
Q

Manufacture of ATG:

rabbits are immunized with human ___

A

thymocytes

serum harvested from rabbits, immunoglobulins against human thymocytes isolated/purified

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8
Q

rATG is infused over ___ hours initially

A

6

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9
Q

Peripheral rATG infusion requires addition of __ and __ to the bag

A

heparin, hydrocortisone

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10
Q

rATG ADRs:

Post transplant lymphoproliferative disorder (PTLD) is associated with what virus?

A

Epstein Barr

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11
Q

rATG ADRs:

Infection is associated with profound lymphopenia for >= __ to __ months

A

3, 6

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12
Q

If platelets are < ___ hold rATG administration

A

50

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13
Q

If WBCs are < ___ hold rATG administration

A

2

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14
Q

4 ADRs of rATG?

A

cytokine-release syndrome
cytopenias
infection
post-transplant lymphoproliferative disorder (PTLD)

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15
Q

Monoclonal induction:

Basiliximab is a chimeric monoclonal antibody against ___ antigen/IL2 receptor

A

CD25

CD25 is on activated T cells;
basiliximab inhibits T-cell proliferation through inhibition of IL2 signaling

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16
Q

Basiliximab does not deplete T cells but makes them inactive for __ to __ weeks

A

4, 6

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17
Q

Basiliximab is T-cell depleting

a. true
b. false

A

b. false

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18
Q

___ is used for induction and rejection

a. rATG
b. basiliximab

A

a. rATG

basiliximab only for induction

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19
Q

No pre-medicaiton is required for induction with basiliximab

a. true
b. false

A

a. true

virtually no ADRs

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20
Q

Glucocorticoids display anti inflammatory and immunosuppressive activity by blocking __ expression

A

cytokine

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21
Q

Glucocorticoids are used for ___

a. induction
b. maintenance
c. cellular rejection

select al that apply

A

a-c

maintenance dose Is 5mg

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22
Q

PRA > __ % needs potent induction

A

20

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23
Q

___ prevents long term allograft rejection

a. induction
b. maintenance

A

b. maintenance

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24
Q

4 classes of maintenance immunosuppressants?

A
  • calcineurin inhibitors
  • anti-proliferatives
  • corticosteroids
  • costimulation inhibitors
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25
Q

Signal one is ___

a. TCR
b. costimulation molecules
c. binding of IL2 to CD25 receptor

A

TCR

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26
Q

Signal two is __

a. TCR
b. costimulation molecules
c. binding of IL2 to CD25 receptor

A

b. costimulation molecules

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27
Q

Signal 3 is ___

a. TCR
b. costimulation molecules
c. binding of IL2 to CD25 receptor

A

c. binding of IL2 to CD25 receptor

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28
Q

Maintenance:

Which calcineurin inhibitor has erratic absorption/poor bioavailability and requires bile salts?

A

cyclosporine non-modified

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29
Q

Cyclosporine modified is interchangeable with or bioequivalent o cyclosporin non-modified

a. true
b. false

A

b. false

NOT interchangeable

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30
Q

Calcineurin inhibitors prevent dephosphorylation of ___

A

NFAT

NFAT cannot enter the nucleus to activate T lymphocytes

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31
Q

Calcineurin inhibitors block which signal?

a. 1
b. 2
c. 3

A

a. 1

TCR

results in inhibition of IL2 mediated T lymphocyte activation

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32
Q

Which correlates better with clinical outcomes of calcineurin inibitrors?

a. Co (12 hr trough)
b. C2 (2 hr peak)

A

b. C2 (2hr peak

Co doesn’t correlate clearly with aUC but is easiest to obtain, so most frequently used

33
Q

What HEENT AE does cyclosporine cause?

A

gingival hyperplasia

34
Q

What CV AEs does cyclosporine cause?

A

HTN

hyperlipidemia

35
Q

Which is more nephrotoxic cyclosporine or tacrolimus?

A

a. cyclosporine

36
Q

Cyclosporine causes hirsutism

a. true
b. false

A

a. true

37
Q

Tacrolimus binds to ___

A

FKBP12

NFAT cannot enter nucleus to activate IL2 gene transcription

38
Q

___ is more effective at preventing rejection

a. tacrolimus
b. cyclosporine

A

a. tacrolimus

39
Q

Reduce oral tacrolimus dose by ___ % for sublingual dose

A

50

40
Q

Administer only __ % of tacrolimus PO dose if giving it IV continuous infusion

A

25

41
Q

Which causes more tremor?

a. tacrolimus
b. cyclosporine

A

a. tacrolimus

42
Q

Which causes more diabetes and alopecia?

a. tacrolimus
b. cyclosporine

A

a. tacrolimus

43
Q

Azathioprine is what drug class?

A

antimetabolite

44
Q

Azathioprine is a prodrug and is converted to ___

A

6-MP

purine analog

blocks de novo synthesis of purines

45
Q

Azathioprine blocks which signal?

a. 1
b. 2
c. 3

A

c. 3

inhibits proliferation of rapidly dividing cells including T and B lymphocytes

46
Q

Azathioprine is primarily ___ eliminated

A

renally

47
Q

Azathioprine is 100% bioavailable

a. true
b. false

A

a. true

48
Q

TDM is required for calcineurin inhibitors

a. true
b. false

A

a. true

49
Q

TDM is not typically performed for azathioprine

a. true
b. false

A

a. true

50
Q

What is main AE of azathioprine?

A

hepatotoxicity

51
Q

Monitor renal function with azathioprine

a. true
b. false

A

a. true

52
Q

DDIs:

Azathioprine and allopurinol should not be administer concomitantly

a. true
b. falsel

A

a. true

53
Q

antimetabolites: maintenance

mycophenolate mofetil and mycophenolate sodium are converted to ___

A

mycophenolic acid (MPA)

exhibitors key enzyme for purine biosynthesis

54
Q

Mycophenolate blocks which signal?

a. 1
b. 2
c. 3

A

c. 3

blocks signal necessary for proliferation of T and B lymphocytes

55
Q

When converting MMF to MPS, 250mg MMF = ___ mg MPS

A

180

56
Q

1000mg MMF = __ mg MPS

A

720

57
Q

TDM is typically performed with mycophenolate

a. true
b. false

A

b. false

58
Q

Consider dose reduction or d/c of antiproliferative in the setting of ongoing ___

A

infection

59
Q

PPIs do not impact ___ absorption

a. MMF
b. MPA
c. MPS

A

c. MPS

60
Q

___ pH is necessary for MMF solubility

a. acidic
b. alkaline

A

a. acidic

61
Q

Sirolimus MOA?

A

prevents G1 to s phase of cell cycle

blocks signal 3, IL2 mediated T lymphocyte proliferation

62
Q

TDM is required with mTORs

a. true
b. false

A

a. true

sirolimus, tacrolimus

63
Q

Goal level for sirolimus?

A

5-10ng/mL

Co (24hr trough) correlates to AUC and clinical outcomes

64
Q

Which maintenance Tx can cause hypertriglyceridemia, thrombosis, proteinuria, and delayed wound healing?

A

sirolimus

65
Q

Which maintenance treatment has a BBW for liver and lung transplant?

A

sirolimus

66
Q

Avoid sirolimus within how long of liver transplant?

A

one month

avoid within 3 months of lung transplant

67
Q

Which mTOR has better bioavailability?

a. sirolimus
b. everolimus

A

b. everolimus

30% vs 15%

68
Q

Check everolimus level every __ hours

A

12

sirolimus = 24hrs

69
Q

Everolimus has same side effects as sirolimus, but is better tolerated

a. true
b. false

A

a. true

70
Q

Is TDM performed with prednisone?

A

no

71
Q

belatacept drug class?

A

co-stimulation inhibitor

binds to APC (CD80/86) and blocks co stimulation signal

blocking signal 2 prevents T-lymphocyte activation and can cause anergy and apoptosis

72
Q

Is TDM performed for the costimulation inhibitor belatacept?

A

no

DDI are minimal

73
Q

Belatacept exposure is not impacted by renal or hepatic function

a. true
b. false

A

a. true

linear kinetics

74
Q

3 main side effects of the costimulation inhibitor belatacept?

A

infusion reactions
malignancy
diarrhea

post transplant lymphoproliferative disorder more frequent in eBV seronegative (IgG -) pts

75
Q

Acute cellular rejection is mediated by what?

A

T-lymphocytes

76
Q

mild to moderate cellular rejection receives what Tx?

A

methylprednisolone

augmentation

77
Q

moderate to severe cellular rejection receives what Tx?

A

methylprednisolone
augmentation
T-lymphocyte depleting agent

78
Q

Antibody mediated rejection is mediated by what?

A

donor specific antibodies

DSAs secreted by mature B lymphocytes (plasma cells)

7361 Hem/Onc Block 3 (9 decks)

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